Danish guidelines on management of otitis media in preschool children
C H Heidemann1, J Lous2, J Berg3
1Danish Health and Medicines Authority, Denmark; Department of ENT - Head & Neck Surgery, Odense University Hospital, Denmark; Department of Otorhinolaryngology, Vejle Hospital, Denmark.
Insights
Updated Danish guidelines offer stricter diagnostic criteria for acute otitis media (AOM) and surgical management recommendations for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) in children.
Area of Science:
- Otolaryngology
- Pediatrics
- Public Health
Background:
- Otitis media is a prevalent childhood illness, necessitating optimized diagnosis and treatment strategies.
- Ventilating tube insertion for recurrent and chronic otitis media is a common pediatric surgical procedure.
- Existing guidelines required updating to reflect current evidence and clinical practices.
Purpose of the Study:
- To update Danish national guidelines for diagnosing acute otitis media (AOM).
- To provide evidence-based recommendations for the surgical management of recurrent AOM (RAOM) and chronic otitis media with effusion (COME).
- To address the role of adenoidectomy and manage ventilating tube otorrhea.
Main Methods:
- Utilized the GRADE system for evidence assessment.
- Conducted a comprehensive literature search from July to December 2014.
- Employed rigorous quality appraisal tools (AGREE II, AMSTAR, QUADAS-2, Cochrane Risk of Bias, ACROBAT-NRSI).
- Multidisciplinary working group including specialists in otolaryngology, general practice, pediatrics, microbiology, and epidemiology.
Main Results:
- Proposed updated recommendations for AOM diagnosis.
- Provided guidelines for surgical interventions in RAOM and COME.
- Included recommendations on adenoidectomy and management of ventilating tube complications.
Conclusions:
- The updated guidelines aim to standardize and improve the care of children with otitis media.
- Stricter diagnostic criteria for AOM are suggested.
- Evidence-based surgical management strategies for RAOM and COME are outlined.
Introduction:
Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatment for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME.
Methods:
The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists.
Conclusion:
Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline.
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